
      <table>

	
	<tr>
	  <td>
	    Email:
	  </td>
	  <td>
	     <input type='text' name='email' size='10' />
	  </td>
	</tr>
	<tr>
	  <td>
	    Name:
	  </td>
	  <td>
	    <input type='text' name='name' size='10' />
	  </td>
	</tr>
	<tr>
	  <td>
	    Password:
	  </td>
	  <td>
	    <input type='text' name='name' size='10' />
	  </td>
	  <td>
		<input type="button" value="Change"/>
	  </td>
	</tr>
	<tr>
	  <td>
	    Allergens:
	  </td>
	  <td>
	    <select name="allergens">
		<option value="#">Select an Allergent</option>
		<option value="Nuts">Nuts</option>
		<option value="Lactose">Lactose</option>
		<option value="Fructose">Frusctose</option>
		<option value="Sacharose">Sacharose</option>
	    </select>
	  </td>
	  <td>
		<input type="button" value="Add"/>
	  </td>
	</tr>
	<tr>
	  <td>
	    Alert me:
	  </td>
	  <td>
	    <select name="misc">
		<option value="#">Select an option</option>
		<option value="halaal">Halaal</option>
		<option value="without_gmo">Without GMO</option>
	    </select>
	  </td>
	  <td>
		<input type="button" value="Add"/>
	  </td>
	</tr>
	<tr>
	  <td colspan="2">
	    <input type="button" value="View Terms and Conditions"/>
	  </td>
	  <td>
	    <input type="button" value="Submit"/>
	  </td>
	</tr>
</table>
 